WASHINGTON, D.C. – In response to a recent report from the VA’s Office of Inspector General (OIG), U.S. Senators Angus King (I-ME), Jon Tester (D-MT), and Sherrod Brown (D-OH), all members of the Senate Veterans’ Affairs Committee (SVAC), are pressing the VA to improve oversight of its Community Care Network contracts to ensure veterans have timely access to providers in the community. In a letter to VA Secretary Denis McDonough, the Senators urge the VA to take immediate steps to remedy the issues outlined in the report.
“We write today to express our frustration with the Department of Veterans’ Affairs (VA) lack of oversight of Community Care Network adequacy,” the Senators wrote. “The Community Care Network was designed to improve care coordination and make it easier for community providers and VA staff to serve veterans by expanding access to health care...Ineffective oversight, however, left VA medical facilities with insufficient access to a network of community providers who meet the needs of veterans.”
The Senators’ letter cited the VA OIG report, which detailed how the VA’s Office of Integrated Veteran Care (IVC), the office responsible for overseeing community care access, “provided ineffective oversight” of its Community Care Network’s third-party administrators (TPAs), TriWest and Optum. It found that IVC did not ensure these administrator-maintained provider networks accepting VA patients—a requirement in their contract with the VA. This requirement is in place to ensure VA facilities have enough community providers to deliver care to veterans within the defined timelines and drive-time standards.
Underscoring their concerns with the report’s findings, the Senators continued, “[D]ue to network inadequacies, VA medical center staff reported spending hours trying to find community providers who will accept veteran patients and cite this issue as one of the biggest roadblocks to the timely scheduling of appointments. Staff at many facilities created their own provider lists on spreadsheets to ensure they have accurate and complete information for community providers…VA staff should not be put in a position where they need to rely on workarounds to schedule appointments in the community.”
They highlighted examples of VA community care managers in Maine—in addition to Montana and Ohio—who maintain their own internal lists of Community Care Network providers who will accept VA patients. In addition to relying on inaccurate provider lists, the Senators also noted how VA medical facility staff have reported that the Community Care Network administrators refuse to update inaccurate provider information and deny requests to add more providers to the network.
The Senators concluded, “When the OIG asked the TPAs why they didn’t add more providers to the network, both TriWest and Optum cited the costs associated with adding providers. This is completely unacceptable. The TPAs are contractually obligated to build and maintain an adequate network of community providers that actually accept veteran patients. IVC has failed to oversee the Community Care Network contracts and must immediately take steps to remedy the issues outlined in the report.”
Representing a state with one of the highest rates of veterans per capita, Senator King is a staunch advocate for America’s servicemembers and veterans. A member of the Senate Veterans’ Affairs Committee, he works to ensure American veterans receive their earned benefits and that the VA is properly implementing various programssuch as thePACT Act,theState Veterans Homes Domiciliary Care Flexibility Act,and theJohn Scott Hannon Act. King has alsorepeatedly pressed the VAon the need to hire and retain more staff in order to meet the demand for veteran care. An advocate for amplifying veteran voices, King held afield hearingin January focusing on long-term care in Maine. He also spearheaded the passage oflegislation to better track and study servicemember suicidesby job assignment. Last year, King introducedbipartisan legislationto support veterans with mental traumas, as well as celebrated President Bidensigning his legislation into law, which increases benefits for veterans and military families. Most recently, he introduced theLong-Term Care Workforce Support Actto help revitalized the American long-term care workforce by making jobs more attractive and better compensated.
Read the Senators’ full letter HERE or below.
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Dear Secretary McDonough,
We write today to express our frustration with the Department of Veterans Affairs’ (VA) lack of oversight of Community Care Network (CCN) adequacy. The CCN was designed to improve care coordination and make it easier for community providers and VA staff to serve veterans by expanding access to health care, improving customer service, enhancing how health information is exchanged, and refining the referral and scheduling process. Ineffective oversight, however, left VA medical facilities with insufficient access to a network of community providers who meet the needs of veterans.
The recent report from the Office of Inspector General (OIG) entitled, Improved Oversight Needed to Evaluate Network Adequacy and Contractor Performance, concluded VA’s Office of Integrated Veteran Care (IVC), responsible for overseeing community care access, provided ineffective oversight of VA’s contracts with the CCN network’s two third-party administrators (TPAs)—Optum and TriWest. Specifically, IVC did not ensure the TPAs maintained provider networks accepting VA patients and had no mechanism for facilities to collect and report challenges with CCN network adequacy.
The CCN contracts include network adequacy requirements to ensure facilities have enough community providers to administer care to veterans within the defined timeliness and drive-time standards. However, due to network inadequacies, VA medical center staff reported spending hours trying to find community providers who will accept veteran patients and cite this issue as one of the biggest roadblocks to the timely scheduling of appointments. Staff at many facilities created their own provider lists on spreadsheets to ensure they have accurate and complete information for community providers.
For example, Fort Harrison’s community care manager said an analyst pulls the CCN provider repository daily, highlights new providers added, calls them to confirm they will accept new VA patients, and then adds these providers to their own provider spreadsheet. A Togus community administrative manager also said facility staff compared the CCN provider repository to their internal spreadsheets once a week to ensure their lists contained all available providers.
Similarly, Cleveland’s community care chief said identifying available providers is a continuous process and they update their internal spreadsheets as they identify other available providers or remove providers who stop accepting VA patients. VA staff should not be put in a position where they need to rely on workarounds to schedule appointments in the community.
Additionally, VA medical facility staff reported the TPAs refuse to update inaccurate provider information and generally deny requests to add more providers to the network by relying on the same inaccurate provider repositories. When the OIG asked the TPAs why they didn’t add more providers to the network, both TriWest and Optum cited the costs associated with adding providers. This is completely unacceptable. The TPAs are contractually obligated to build and maintain an adequate network of community providers that actually accept veteran patients. IVC has failed to oversee the CCN contracts and must immediately take steps to remedy the issues outlined in the report. Furthermore, given CCN contracts are up for rebidding in the fiscal year 2026, VA must determine what contractual changes should be made to future language to ensure the Department can better hold the TPAs accountable for network adequacy.
As part of VA’s response to this letter, we ask for answers to these questions:
- In the response to recommendation #2 of the OIG Report regarding provider lists, VA responded that TPAs are not contractually required to provide updates regarding providers that are not currently seeing veteran patients.
- What steps will IVC take to ensure the TPAs are not relying on an inaccurate provider repository to justify not adding additional providers?
- Does IVC track how many providers in each TPA’s repository are not currently accepting VA patients?
- How will IVC hold the TPAs accountable for regularly updating their provider lists to reflect accurate information?
- Is requiring the TPAs to update provider data to reflect providers who no longer want to be in the network or are not seeing veterans something VA is exploring for the next generation of CCN contracts regardless of whether it is industry standard?
- Regarding recommendation #4, what is the standardized process IVC developed for requesting and documenting additional providers? How has IVC communicated that process to all VHA facilities?
- Regarding the Advanced Medical Cost Management Solution (AMCMS) network adequacy suite, when will IVC complete the verification process of reports? Have community care staff at all facilities been granted access to AMCMS and been trained on its functionality? Has IVC begun using AMCMS to monitor network adequacy on a consistent basis?
- Regarding recommendation #6 and network adequacy performance reports, how is appointment availability measured?
Thank you for your attention to this matter. We look forward to hearing more about VA’s efforts to provide oversight of the Community Care Networks.
Sincerely,
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